# FAMILY PRACTICE CENTER OF BRANDON LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487962619
- **Authorized official:** DR. MIGUEL MAZARIEGOS M.D. (PHYSICIAN)
- **Authorized official phone:** (813) 681-6064

## Contact information

- **Practice address:** 814 VITTORIO PL, BRANDON, FL 33511-6659
- **Practice address phone:** (813) 681-6064
- **Practice address fax:** (813) 653-4132
- **Mailing address:** 814 VITTORIO PL, BRANDON, FL 33511-6659
- **Mailing address phone:** (813) 681-6064
- **Mailing address fax:** (813) 653-4132

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | ME0069553 | FL | Yes |

## Other

- **Enumeration date:** 09/22/2010
- **Last updated:** 10/25/2023